Background: Assaults with a machete cause compound skull fractures which present as a neurosurgical
emergency. We aimed to profile cranial injuries caused by a machete over a 10 year period in a single
neurosurgical unit.
Materials and methods: Retrospective data analysis of cranial injuries following assault with a machete,
admitted to the neurosurgery ward, from January 2003 to December 2012 was performed. Medical
records were analyzed for demographics, clinical presentation, CT scan findings, surgical treatment and
Glasgow Outcome Scale (GOS) at discharge. Management involved wound debridement with antibiotic
cover.
Results: Of 185 patients treated 172 (93%) were male. Mean age was 31 11.4 years. Mean GCS on
admission was 13 2. Presenting features were focal neurological deficit (48%), brain matter oozing from
wounds (20%), and post traumatic seizures (12%). Depressed skull fractures were found in 162 (88%) patients.
Findings on CT brain scan were intra-cranial haematoma (88%), pneumocephalus (39%) and features of raised
intra-cranial pressure (37%). Thirty-one patients (17%) presented with septic head wounds. One hundred and
fifty seven patients (85%) were treated surgically. The median hospital stay was 8 days (range 1–145). The
median GOS at discharge was 5 (range 1–5). Twelve patients died within the same admission (6.5%).
Conclusion: Machetes cause complex cranial injuries with associated neurological deficit and should be
treated as neurosurgical emergency. Timeous intervention and good surgical principles are advocated to
prevent secondary infection and further neurological deterioration.